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Biopsy Of The Roof Of The Mouth

Ohio rates for HCPCS 42100

Takes a small piece of tissue from the roof of the mouth or from the uvula, the flap hanging at the back of the throat, so it can be examined under a microscope. Only a sample is taken and the rest of the area is left in place. It is done to find out what is behind a patch, sore, swelling or growth that has not settled on its own.

Rates data updated July 2026.

How much does Biopsy Of The Roof Of The Mouth cost?

$145

Typical negotiated rate. In Ohio, July 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $141 from a physician practice, and about $2,630 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$141$115 to $174
FacilityA hospital or hospital-owned outpatient department$2,630$912 to $4,266

How much rates vary

Facilitymedian $2,630 · 10th to 90th $178 to $9,772Professionalmedian $141 · 10th to 90th $102 to $229
$100$200$500$1K$2K$5K$10Kfacility $2,630professional $141

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$2,630.27
Typical High
$10,715.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$141.25
Typical High
$223.87
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$144.54
Typical High
$144.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$2,691.53
Typical High
$7,943.28
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$134.90
Typical High
$218.78
CareSource
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$114.82
Typical High
$134.90
CareSource
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$128.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$575.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$323.59
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$363.08
Typical High
$575.44
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$323.59
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$72.44
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$2,398.83
Typical High
$2,398.83
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$154.88
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$2,137.96
Typical High
$4,897.79
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$144.54
Typical High
$239.88

Where Ohio sits

The same service costs 2.1 times more in Minnesota than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Ohio· 47th of 51

$145

MN $282HI $135

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.